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Healthy Food and Nutrition During the Cancer Journey Native Families Cancer Caregiver Workshop May 28-30, 2008 • Objective – Describe the basics of nutrition intervention during cancer treatment, and nutrition for cancer prevention. “Before we can start talking about nutrition, we have to renew the spiritual connection our people had with food as a gift from the Creator. It makes sense for us to renew our bodies with that traditional source” -- L. DeCora, RN, Winnebago Tribe (as quoted in LaDuke, 2005, p. 20) Images of Wellness Slow foods - absorption keeps pace with insulin production Original American Foods Three out of every 4 plants we eat today were first grown by Native Americans. Tomato Coffee Beans Tobacco Peanuts Cocoa Sunflowers Cranberry Avocado Pumpkin Squash Pineapple Food System Change Our Changing Diet Composition Hunter/Gatherer Diet Early Reservation Era Modern Diet 20% 15% Protein 28% 25% 40% 37% Carbo's 40% Fat 47% 48% Source: Yvonne Jackson, 1994, Diabetes: A Disease Source: The Strong of Civilization. Mouton de Heart Study, 1993 Gruyter. Welty, Zephier. Current Diets of Native Americans Since the 1960’s most Native Pro American’s had diets similar Fat 15-17% in composition (pro/carb/fat) 35-40% Carb to that of the non-Indian 45-50% population, intakes have been shown to be similar as well. Source: The Strong Heart Study, 1993 Welty, Zephier. Current Diets (continued) About 65% of Native American’s living on Nutrient Mix: Commodity Food reservations receive either food commodities 28% 14% or food stamps. Intermittent 58% Food Insecurity Protein Carbos Fat exists in 9% of families. Introduced Food System Obesity Promoting Environment Highly refined packaged foods White and other refined flours High fructose corn syrup Saturated and trans fats High sodium/salt Deep fried Sugared/artificially sweetened drinks Sedentary lifestyle Food Sovereignty • “Food Sovereignty” – Rights of peoples to define how they will hunt, grow, gather, sell, or give food with respect to their culture and management of natural resources (International Indian Treaty Council, 2002) • Native people’s loss of land and resources has impacted “food sovereignty” • Food assistance programs and a “westernization” of lifestyles have impacted Native American health and wellness Many Native people consider the restoration of traditional subsistence foods and practices as essential in order to regain their health, traditional economy and culture for generations to come. Tribal Food System Initiatives Gardening Projects lead by Tribal Colleges Buffalo Herds: both tribal and private Traditional harvesting and gathering of foods. Native American Natural Foods Based in Kyle, SD on the Pine Ridge Reservation Made from all-natural buffalo and cranberries, two indigenous foods from Native America. Comparison of Meats (3.5 oz Portion) Hot Dog Ground Buffalo Fat - 25 grams Fat - 2.4 grams Protein - 12 grams Protein - 28.4 grams Saturated Fat – 10 Saturated Fat – 1 gr. g Contains Essential Contain Fatty Acids Nitrates/Salt Current Food Guide Pyramid…. Key Messages: •Focus on Fruits •Vary your veggies •Get your calcium-rich foods •Make half your grains whole •Go lean with protein •Know the limits on fats, salt, and sugars Personalizable at: MyPyramid.gov Cancer Prevention American Cancer Society Guidelines on Diet and Nutrition • Choose most of the foods you eat from plant sources. • Eat five or more servings of fruits and vegetables each day. • Eat grains and starchy vegetables: corn breads, cereals, rice, pasta, & beans. Cancer Prevention American Cancer Society Guidelines on Diet and Nutrition • Limit your intake of red meats. • Choose low-fat dairy products. • Use foods and beverages low in sugar. • Limit alcoholic beverages if you drink at all. Cancer Prevention American Cancer Society Guidelines on Diet and Nutrition • Be physically active – achieve and maintain a healthy weight. • Be at least moderately active for 30 minutes or more on most days of the week. • Stay within your healthy weight range. Source: http://www.tribalconnections.org/health_news/native_roots/april2004p1.html Kibbe Conti, Registered Dietician, Northern Plains Nutrition Consulting Nutrition during Cancer Treatment Nutrition intervention in Cancer Care: • Good nutrition is important during cancer treatment because it: – Keeps up the body’s ability to fight infection – Preserves and rebuilds body tissues – Improves strength and energy Nutrition in Cancer Care • Goals: – Prevent weight loss even in overweight patients. – Maintain lean muscle mass/protein reserves. – Nutrition therapy to improve management of some symptoms and improve quality of life. Nutrition Support with Enteral Tube feedings • Malnourished patient undergoing surgery • Management of the critically ill patient • Patients undergoing bone marrow transplant • Patients treated for pancreatic cancer • Patients with head and neck cancer Tips About Fluids • Take small sips often • Do not drink too much at once • Keep a small glass of water or juice at bedside or next to chair • Use a straw for small sips • Use ice chips to relieve dry mouth Involuntary Weight Loss • Many individuals going through cancer treatment lose weight • Try increasing calories and protein by using certain foods/ingredients to prepare foods: – Add 1-2 tsp. butter, to hot cereal. Add cream to soups, sauces. – Add eggs to salads, casseroles, etc. – Use more cheese on sandwiches, in soups, with rice and noodles, etc. – Make a fruit smoothie with fruit, juice, ice and protein powder. General Caregiver Nutrition Tips • Help your loved one make the most of the good days – Keep ready-to-serve and easy-to-prepare foods available: peanut butter, pudding, tuna, protein bars, trail mix, cheese and crax and boiled eggs. – Serve small portions, large portions might overwhelm patient. • If getting enough calories and protein from food becomes a problem, you may need to try liquid meal replacements (e.g., Ensure, protein bars) – Don’t try to force person to eat Taste and Smell Alterations Changes in the usual patterns of taste perception • Decreased taste sensitivity • Absence of taste sensation • Distortion of normal taste Common Taste Alterations • Decreased taste threshold for bitter foods • Aversion to foods with high amino acids: chocolate, coffee, red meats. • Increased threshold for sweet foods: need increased sugar to taste sweetness • Metallic or medicinal taste may be sensed continuously even when not eating • Decreased threshold for salty foods Suggestions for Altered Taste • If foods too sweet, addition of lemon or sour sauces or salt may decrease sweetness. • Serve more poultry, fish/shellfish and eggs. • Marinating meats in fruit juice or commercial marinade may disguise bitter taste. • Plastic utensils may be used if metallic taste Nausea & Vomiting • Eat multiple small meals or snacks instead of 3 large ones. • Eat dry foods upon wakening and throughout the day: crackers, dry toast. • Avoid foods with strong odors. • Avoids foods that are overly spicy, fried, or sweet. Nausea & Vomiting • Avoid being in the area where food is prepared. • Drink adequate fluid with an additional ½ cup to 1 cup liquid for each episode of vomiting. • Take antiemetic (anti-nausea) meds as ordered. Low White Blood Cell Count Food safety guidelines • Discard leftovers stored at room temp. for more than 2 hours. • Discard leftovers older than 2 days. • Do not drink directly from cans. Wash can before opening and use a cup. • Thaw frozen foods in the refrigerator or in cold water. Low White Blood Cell Count Food safety guidelines • Cook meats thoroughly (165 F). • Wash hands before food preparation. • Use separate cutting boards for produce and meat. • Don’t eat raw vegetables, fruits. – Banana, juices, melon and canned fruits okay. Diarrhea Nutrition Therapy • Limits caffeine, fat and concentrated sweets. • Choose foods with less than 2 grams fiber • No raw vegetables, no broccoli, cabbage... • No raw fruits except banana and melons. • Offer rehydration beverages, water and or caffeine free teas. Nutrition for Cancer Survivors Nutrition After Cancer Treatment • Return to healthy weight – Right after treatment ends, cancer survivors should plan their nutrition so that their weight returns to a healthy, normal level. – Exercise is important in restoring lean muscle mass. Nutrition for Long-Term Cancer Survivors • After the body has returned to a healthy balance, follow nutrition recommendations for a healthy lifestyle – Keep weight within normal limits – Limit high fat foods – Eat plenty of fruits and vegetables – Choose fresh, lean meats – Exercise – Follow instructions for any special diets (example: diabetic diets, low salt diets) The Caregiver’s Nutrition • Caregivers may gain or lose weight while their loved one goes through cancer treatment or during end-of-life care. • Caregivers may not feel like eating. • They may not have time to prepare their own meals. • Caregiver supporters should help caregiver meet their own nutrition needs. Questions for Discussion • How can a community help caregivers maintain their own healthy nutrition while a loved one is getting treated for cancer? • How can a community help caregivers with nutrition during end-of-life care?
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